Perinatal outcomes for rural obstetric patients and neonates in rural-located and metropolitan-located hospitals

Objective: To compare rural obstetric patient and neonate characteristics and outcomes by birth location. Methods: Retrospective observational cohort study of rural residents’ hospital births from California, Pennsylvania, and South Carolina. Hospitals in rural counties were rural-located, those in metropolitan counties with ≥10% of obstetric patients from rural communities were rural-serving, metropolitan-located, others were non-rural-serving, metropolitan-located. Any adverse obstetric patient or neonatal outcomes were assessed with logistic regression accounting for patient characteristics, state, year, and hospital. Results: Of 466,896 rural patient births, 64.3% occurred in rural-located, 22.5% in rural-serving, metropolitan-located, and 13.1% in non-rural-serving, metropolitan-located hospitals. The odds of any adverse outcome increased in rural-serving (aOR 1.27, 95% CI 1.10–1.46) and non-rural-serving (aOR 1.35, 95% CI 1.18–1.55) metropolitan-located hospitals. Conclusion: One-third of rural obstetric patients received care in metropolitan-located hospitals. These patients have higher comorbidity rates and higher odds of adverse outcomes likely reflecting referral for higher baseline illness severity.